Decellularized Fresh Aortic Valved Homografts as Aortic (Valve) Replacement: Preliminary Experience with 25 Patients Observed up to 5 years

Background: Homografts have limited durability and degenerate early especially in young patients. After encouraging experience with decellularized homografts (DH) in pulmonnary position, we started implanting them in the aortic position.

Patients and Methods: From 2008 to 2013, 25 DHs were implanted. 111 postoperative examinations took place. One patient was < 1 year, three were 1 to 5 years, two were 9 years, and the remaining patients > 40 years. Overall 10 patients (40%) had acquired aortic valve disease, 3 (12%) bicuspid aortic valves, 12 (48%) congenital malformations. Total follow-up is 36.5 years. Findings were collected preoperatively following a standardised protocol.

Results: No homograft was explanted, no stenosis leading to peak gradients of more than 50 mm Hg was seen, no moderate or greater insufficiency was seen. Two patients had mild-to-moderate insufficiency, of which one was stable and the other one decreased over time. One patient with a 10 mm conduit developed a stenosis with a peak gradient of 44 mm Hg. All others function perfectly with very low peak gradients. Since no valve was sized to require growth up to now, no statement concerning growth potential can actually be given.

Conclusion: At 5 years, the authors see decellularized fresh aortic valved homografts performing very promisingly.